Diffusion of HIV-1 among Drug Using Men in SE Asia

HIV-1 在东南亚吸毒男性中的传播

基本信息

批准号：
7420863
负责人：
Michael C. Clatts
金额：
$ 53.42万
依托单位：
UNIVERSITY OF PUERTO RICO MED SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-07-15 至 2012-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7420863
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Age Alcohols Anus Area Arts Asia Attention Australia Behavioral Biological Markers Biological Testing Bisexual Blood Circulation Cambodia Caring Characteristics China Chlamydia Cities Class Client Clinical Collaborations Communicable Diseases Communities Complex Country Cross-Sectional Studies Data Data Reporting Databases Destinations Development Diffusion Disadvantaged Doctor of Philosophy Drug usage Economics Education Epidemic Epidemiologic Studies Erythema Infectiosum Ethnography Europe Facility Construction Funding Category Female Funding Generations Genotype Goals Gonorrhea Growth HIV HIV Infections HIV Seroprevalence HIV therapy HIV-1 Health Health Resources Hepatitis B Hepatitis B Virus Hepatitis C Hepatitis C virus Heterogeneity Heterosexuals High Prevalence Home environment Homosexuality Homosexuals Human immunodeficiency virus test Immigration India Individual Infection Injecting drug user Injection of therapeutic agent International Internet Interview Journals Laboratories Malaysia Marketing Marriage Mediating Medical Medical Surveillance Methods Modeling Mutation National Institute of Drug Abuse Nature Numbers Outcome Parenting behavior Pattern Perinatal Personal Satisfaction Pharmaceutical Preparations Play Population Prevalence Prevention program Process Public Health Purpose Rate Recombinants Recruitment Activity Relative (related person)Research Research Infrastructure Research Institute Research Personnel Research Training Resistance Risk Role Rural Safe Sex Self Concept Sentinel Sentinel Surveillance Series Sexual Partners Sexual Transmission Sexually Transmitted Diseases Shame Singapore Social Identification Source South Korea Spouses Stigmata Surveys Syphilis Taiwan Techniques Thailand Thinking Training Universities Vietnam Viral Virus Wages Woman Work Youth base club drug desire early onset epidemiological model experience male men men who have sex with men men&apos s group migration novel programs rural area scale up sex size skills social social stigma transmission process urban area young adult

项目摘要

DESCRIPTION (provided by applicant): This application proposes a mixed method, ethno-epidemiological study of drug and sexual risk among young male sex workers Hanoi and Ho Chi Minh City, Vietnam. There are an estimated 8.3 million individuals with HIV infections in Asia, one fifth the disease burden worldwide. Initially thought to be confined to circumspect populations of male IDUs and female sex workers, it is now clear that men who have sex with men are also at high risk. Of particular concern is that concurrent with the rapid increases in STI and HIV infection among young adult male populations in the region, there has also been an expansion of markets for male sex work and international male sex tourism. Largely from socially and economically disadvantaged social strata, many male sex workers have concurrent female heterosexual partners. This constellation of sexual partnering has the potential to contribute to increased heterosexual and perinatal transmission and development of a generalized epidemic. This may also contribute to diffusion of novel subtypes and multiply resistant forms of HIV-1, reflecting the high background prevalence of these viruses in the countries from which much of the international sex tourism client base originates, potentially adding even greater challenge to attempts to "scale up" ARV therapy. The study will be conducted in and through an existing collaboration between researchers at National Development and Research Institutes, Inc. (NDRI), Hanoi Medical University, and the Wadsworth Viral Genotyping Laboratories of the NY Department of Health, and a new collaboration with the Ho Chi Minh City Provincial AIDS Committee. In Study 1, formative ethnography will be used to describe the settings, venues, and overall social milieu in which male sex work is being situated. In Study 2, we will conduct a Capture-Recapture Survey to estimate the size of the male sex worker population in each city. In Study 3, we will conduct a broad cross-sectional study for the purpose of construction of a comprehensive ethno-epidemiological profile of behavioral HIV risk among male sex workers. Study 4 will assess the negative medical consequences in this population using biological markers to screen for the presence of HIV-1, HBV, HCV and STIs, including the use of DBS methods to assess the presence of novel HIV subtypes and treatment-resistant strains of HIV. In Study 5, we will recruit young men who have recently initiated male sex work for participation in a one year series of ethnographic interviews to describe the unique vulnerabilities associated with the early course of male sex work. Study 6 will use data from the earlier studies to develop epidemiological models to assess the impact of behavioral risk among male sex workers on the diffusion of HIV-1 in Hanoi and Ho Chi Minh City. PUBLIC HEALTH RELEVANCE This study seeks to address an important public health question: what is the impact of male sex work on the growing HIV epidemics in Hanoi and Ho Chi Minh City, Vietnam? HIV rates in Vietnam are rapidly increasing, and yet there are limited data on the role that different populations play in this increase. Existing data are based on the assumption that HIV is found primarily in injection drug users and female sex workers, with only recent attention being paid to men who have sex with men. Beyond these groups, male sex workers, who may engage in sexual exchanges with men from foreign countries with high background HIV seroprevalence rates and other infections (exchanges referred to as international sex tourism), are a high-risk s heterosexual and engage in concurrent heterosexual relationships (including traditional marriage and parenting) and who, due to stigma and shame, avoid clinical care. This high-risk group is therefore a likely bridge to the larger population, and may become infected with novel subtypes of HIV and/or treatment-resistant HIV due to their sexual contact with foreign clients. Through comprehensive behavioral interviews, detailed ethnography, and state-of-the art biological tests (including tests for HIV and HCV subtypes and HIV treatment resistance), we will describe the demographic, social, and economic characteristics of the male sex worker population in Hanoi and Ho Chi Minh City, Vietnam, as well as the unique vulnerabilities associated with the onset and early social course of male sex work. We will also describe the prevalence of negative medical consequences associated with behavioral risk among male sex workers in these cities, including infections such as Syphilis, Gonorrhea, Chlamydia, Hepatitis B, Hepatitis C, and HIV-1 (including the prevalence of HIV and HCV subtype heterogeneity and treatment-resistant HIV). In order to explain the impact of these behavioral risks on the spread of HIV in urban centers in Vietnam, we will use sophisticated mathematical techniques (known as epidemiological modeling) and we will report these data in both academic journals and through local community dissemination meetings held in both Hanoi and Ho Chi Minh City.

描述（由申请人提供）：本申请提出了一种混合方法，对年轻男性性工作者河内和越南胡志明市的药物和性风险的民族流行学研究。亚洲估计有830万人感染HIV感染的人，全球疾病负担五分之一。最初被认为仅限于男性IDU和女性性工作者的人群，现在很明显，与男性发生性关系的男人也处于高风险。特别关心的是，该地区年轻男性人群的性传播感染和艾滋病毒感染的迅速增加，男性性工作和国际男性性旅游的市场也在扩大。许多男性性工作者在社会和经济上处于不利地位的社会阶层，同时有女性异性恋伴侣。性伴侣的这个星座有可能有助于增加普遍流行病的异性恋和围产期传播和发展。这也可能有助于新型亚型和HIV-1的多种抗性形式的扩散，这反映了这些病毒在许多国际性旅游客户群源于的国家中的高背景流行率，这可能会为“扩展” ARV治疗的尝试增加更大的挑战。这项研究将在国家发展与研究机构，Inc。（NDRI），河内医科大学以及纽约卫生部的Wadsworth病毒基因分型实验室与Ho Chi Chi Minh City省级艾滋病委员会的新合作中进行。在研究1中，将使用形成性民族志来描述男性性工作所在的环境，场地和整体社会环境。在研究2中，我们将进行一项捕获回顾调查，以估计每个城市男性性工作者人数的规模。在研究3中，我们将进行广泛的横断面研究，以构建男性性工作者行为HIV风险的全面民族流行病学特征。研究4将使用生物标记物评估该人群中的负面医学后果，以筛选存在HIV-1，HBV，HCV和ETI的存在，包括使用DBS方法评估新型HIV亚型的存在以及HIV的耐药性HIV菌株。在研究5中，我们将招募最近开始男性性工作的年轻男性，以参与一年的民族志访谈，以描述与男性性工作的早期过程相关的独特脆弱性。研究6将使用早期研究的数据来开发流行病学模型，以评估男性性工作者对HIV-1在河内和胡志明市扩散的行为风险的影响。公共卫生相关性本研究旨在解决一个重要的公共卫生问题：男性性工作对河内和胡志明市不断增长的艾滋病毒流行病的影响是什么？越南的艾滋病毒率正在迅速提高，但是关于不同人群在这一增加中所起的作用的数据有限。现有数据基于以下假设：艾滋病毒主要是在注射吸毒者和女性性工作者中发现的，只有最近关注与男性发生性关系的男性。除这些群体外，可能与来自具有较高背景HIV HIV血清阳性率和其他感染的外国男性进行性交的男性性工作者（交易所称为国际性旅游业）是高风险的异性恋者，并从事同意的异性恋关系（包括传统婚姻和育儿），以及由于持久的羞耻和羞耻，避免了同意的异性恋关系。因此，这个高风险群体可能是通往较大人口的桥梁，由于与外国客户的性接触，可能会感染艾滋病毒和/或耐药艾滋病毒的新型亚型。通过全面的行为访谈，详细的民族志和最先进的生物学测试（包括对HIV和HCV亚型的测试以及HIV治疗的耐药性），我们将描述河内和Ho Chi Chi Minh City的男性性工人人口的人口，社会和经济特征，越南，越南，以及与男性的独特性和早期的社交能力相关联。我们还将描述这些城市中男性性工作者的负面医学后果的普遍性，包括梅毒，淋病，衣原体，乙型肝炎，丙型肝炎，乙型肝炎和HIV-1（包括HIV和HIV和HCV子类杂种性杂种性和治疗性HIV）等感染。为了解释这些行为风险对越南城市中心的艾滋病毒传播的影响，我们将使用复杂的数学技术（称为流行病学建模），我们将在学术期刊和Ho Chi Chi Minh City举行的学术期刊和当地社区传播会议上报告这些数据。